Safety and efficacy of aortic coarctation stenting in children and adolescents

Percutaneous aortic coarctation treatment with primary stent implantation is the first choice in adult patients. However, current guidelines do not suggest a lower weight limit to perform this procedure safely. The aim of this study was to retrospectively analyze the safety and the mid-term outcome of aortic coarctation stenting in pediatric age at different patients' weights. We enrolled 47 patients, 8 of them weighting lower than 25 kg, 10 with a weight between 25 and 30 kg and 29 patients with a weight >30 kg. Covered CP stent was used in 32 patients (68.1%), bare CP stent in 6 (12.8%), Andrastent XL in 8 (17.0%) and Palmaz Genesis in one case (2.1%). The balloon mean diameter was 13.8 ± 2.4 mm, range 10-18 mm. The procedure was effective in all patients. The aortic gradient dropped from 28.0 ± 7.8 mmHg to 2.2 ± 2.0 mmHg (p < 0.0001). Hemostasis was achieved by a surgical cut-down in 20 (42.5%) patients, manual compression in 2 (4.3%) or by vascular closure devices (VCDs) in 25 (53.2%) patients. There was no difference in terms of efficacy, safety and complication rate among the three weight-based groups. We found a trend toward higher incidence of vascular complications following hemostasis with VCDs (4/24, 16.7%) vs surgical cut-down (1/21; 4.8%) In conclusion, aortic coarctation stenting is a safe procedure in patients weighing less than 30 kg. Surgical arterial cut-down can minimize the risk of vascular injury by reducing the stress on the arterial wall in smaller patients, or in case, a large sheath is needed.